Lawsuit: Transgender teen's health insurance violated ACA

A lawsuit brought by a Bremerton family says an insurance company violated the Affordable Care Act by failing to cover gender-affirming health care for a transgender teenager.

Pattie Pritchard sued Blue Cross Blue Shield of Illinois on behalf of her 15-year-old son, The News Tribune reported.

“My son needs the medical care that will allow him to live, be healthy, and to thrive,” Pritchard said in a news release. “However, because he is transgender, I have to fight and jump through hoops for him to have access to the care that he needs, is legally entitled to and that he deserves. This denial also sends a message to my son and all transgender people, that their health care needs aren’t real or they’re not worthy of care. I won’t accept that.”

Pritchard works for St. Michael Medical Center. She and the teen are both insured through her employment there. The facility is part of the Catholic Health Initiatives Franciscan Health System, which after a 2019 merger is known as CommonSpirit Health.

One of the family’s attorneys, Eleanor Hamburger, said in a news release that the insurance company can’t hide behind a defense that it was just following orders when Pritchard’s employer told the insurance company to apply “the illegal exclusion.” She said the insurance company has a separate legal, contractual and fiduciary duty to C.P. and others in the health plans it administers, to comply with anti-discrimination law.

A Blue Cross Blue Shield of Illinois spokesperson said she could not comment on pending litigation. CHI Franciscan, which is not a party to the lawsuit, also declined to comment.

The complaint, filed Nov. 23 in U.S. District Court in Tacoma, seeks unspecified damages. It says C.P.’s parents have more than $10,000 in out-of-pocket expenses.

C.P. has been diagnosed with gender dysphoria, which is “a feeling of clinically significant stress and discomfort” a person experiences when there’s “an incongruence between their gender identity and sex assigned at birth,” the lawsuit says.

C.P. started getting “gender-affirming care” three years ago which can include counseling, hormone replacement therapy, surgical care or other treatment. The insurance company covered some of his treatment, but other procedures weren’t covered, even though health care providers found them medically necessary to treat C.P., according to the lawsuit.